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What Happens During IVF?

Below is a summary of the IVF process and then will go into each step in more detail.   This IVF summary mentions the add on ICSI but does refer to other add ons such as PGTa which is chromosomal screening of the Embryos – this will be explained in more detail in a later section.

The IVF Process Summarised

The IVF Process in Detail

Step 1 - Consult with a Fertility Specialist

Before starting IVF you will need an initial consult with a Fertility Doctor which will confirm if IVF is a viable Fertility treatment option for you. It will involve various checks including Hormonal Blood tests and an Ultrasound of your Reproductive system.  Typical things they may look for in your Blood tests are:

  • Follicle Stimulating Hormone (FSH) – controls a womans menstrual cycle and growth of the follicles 
  • Estradiol – measures the function of your ovaries and quality of your eggs
  • Luteinizing Hormone (LH) – linked to ovary hormone production and egg maturation – also can help diagnose hormonal imbalances like PCOS (Polycystic Ovary Syndrome) if done at the beginning of your cycle.  If the test carried out mid cycle can help determine if you are ovulating.
  • Anti-Mullerian Hormone (AMH) – this hormone is secreted by the ovaries and present until a woman reaches Menopause – it gives a good idea of your ovary function and number of eggs you have
  • Progesterone – female hormone produced by ovaries during ovulation which prepares the lining of the uterus and makes it receptive to fertilised eggs

Also the male will undergo Hormonal Blood testing and analysis of their Sperm.  Hormonal Blood Tests can include testing for:

  • Follicle Stimulating Hormone (FSH) – regulates production and transportation of sperm – test is used to determine sperm count
  • Luteinizing Hormone (LH) – stimulates the hormone testosterone which affects Sperm production

Step 2 - Stimulation of the Ovaries

The IVF process typically begins with the stimulation of the ovaries. The goal is to produce multiple eggs for retrieval, as not all eggs will fertilise successfully. Hormonal medications, often in the form of daily injections, are administered to stimulate the ovaries to produce multiple follicles, each containing an egg. Monitoring of hormone levels and ultrasound scans are performed regularly to track follicle growth. When the follicles are shown to have grown to a specific size commonly between 17 to 19mm then a drug is required to encourage the follicles to release the eggs. The usual time for the stimulation phase of the follicles to reach their desired size is 8-14 days but can be longer for some.  You will then be scheduled to have your egg retrieval within a 24-36 hour window after administering the drug that will ensure that ovulation happens and the follicles release their eggs.  

Step 3 - Egg Retrieval

Once you arrive for your egg retrieval you will be asked to change into sterile theatre garments and in the egg retrieval room you will be put into a sedative state to help relax you and make sure do not feel any pain or discomfort during the procedure.  In some cases for Safety reasons your Fertility Specialist may suggest a General Anaesthetic rather than just sedation which they will discuss with you if feel required.  An Ultrasound device is then placed into your vagina to find the follicles then a thin needle is is inserted into the Ultrasound guide to go through the vagina and into the follicles and suction will be applied to collect the eggs. After the procedure you will be taken to a recovery room until the sedation wears off which typically takes approximately an hour.

Step 4 - Sperm Collection and Preparation

Around the same time as you are having your eggs retrieved then a sperm sample is collected from the male partner or sperm donor. The sperm is then washed and processed in the lab which will separate out the better sperm improving its viability and will be prepared for Fertilisation with the eggs.

Step 5 - Sperm Introduced to Eggs

This is the part which is in fact IVF (In-vitro Fertilisation) where the Eggs and Sperm are introduced to each other outside of the body in a culture petri dish (in-vitro).    The eggs retrieved and sperm once combined in the dish in the lab they are incubated in controlled environment and temperature.  They will monitored over the next few days. In some cases if chosen the ICSI (Intracytoplasmic Sperm Injection) may be used where a single sperm is directly injected into the egg to help facilitate fertilisation. If the fertilisation is successful it will result in the formation of an embryo and then the next stage will be to monitor the development of the embryo. If an ideal outcome there will be a number of embyros that fertilised to monitor but in some cases there may be just one or none that managed to fertilise.

Step 6 - Embryo Development Monitored

The resulting embryos that fertilised are cultured in a special incubator, and their development is monitored closely by embryologists. Typically, they are allowed to grow for 3 to 6 days where they will undergo multiple cell divisions becoming embryos.  You may be recommended depending on the outcomes to transfer or freeze the eggs at 3 days, 5 or 6 days. If you choose to do a fresh transfer then any remaining embryos that are good enough quality to have the potential to implant will be frozen so that they can be thawed and used at a future date.  Or if it has been decided a fresh transfer is not the best option in this cycle then all embryos will be frozen and the most viable thawed when ready for doing the transfer. In some circumstances more than 1 embryo may be transferred.

Step 7 - Embryo Transfer

To insert the chosen embryo you will be asked to lie down on a bed which will position your legs apart to enable easier access by your Health Provider. A Speculum will be inserted into the vagina making it stay in a widened position to allow the cervix to be more accessible. Ultrasound will be used to help show your uterus clearly so that the embryo can be guided carefully into the right place. The embryo will then be inserted into the end of the catheter and the catheter guided gently through to release the embryo in the right place.

For a Frozen embryo transfer then when you decide to transfer you will need to start medications on the 1st or 2nd day of your menstruation which will help build up your uterine lining to a certain thickness (monitored by regular ultrasounds).   At the right time the chosen frozen embryo will be thawed and guided by a catheter into the right place.

Step 8 - Implantation and Pregnancy Testing

Over the next few days hopefully the embryo or embryos will implant into your uterine lining. In most cases you will be given supporting medications through either injection, tablet form or vaginal suppository form which will help support the embryo implant into your uterus lining helping to increase the chances of successful pregnancy. A pregnancy test then can be carried out about 10-14 days according to your Health providers recommendations and if the embryo or embryos have successfully implanted into your uterus lining this will cause your ‘Pregnancy Hormone’ HCg Levels to rise which will then give a positive on the test.  Even if you have had a negative or positive on a home test it is always important to have a blood test to confirm Pregnancy as there are cases of False Positives and False Negatives with Home Tests. 

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